Prophylactic Antithrombotic Treatment Research Articles

Rarely Seen Vascular Complication After Treatment in a Covid-19 Patient: Renal Artery Thrombosis

Although respiratory symptoms are dominant in COVID-19 (coronavirus disease-2019) infection, extrapulmonary systemic findings may be seen in the extremely sick group. Studies are showing that patients have a high incidence of arterial and venous thrombotic complications in COVID-19. Acute renal artery thrombosis represents a rarer type of arterial thromboembolism, even among the thrombotic complications of COVID-19 disease. Such complications appear especially during the active phase of the infection. In this article, a rare case of renal artery thrombus in a discharged patient after treatment for COVID-19 pneumonia despite prophylactic antithrombotic treatment is offered.

Spontaneous Intramuscular Hemorrhage in Anti-MDA5 Positive Dermatomyositis: A Case Series and Literature Review.

ObjectiveSpontaneous intramuscular hemorrhage (SIH) is a rare but life-threatening complication associated with dermatomyositis (DM). This study reported a case series of SIH associated with DM. In addition, the characteristics and prognostic effects for this complication were analyzed based on literature review.MethodsWe reported seven cases of anti-melanoma differentiation-associated gene five positive dermatomyositis (MDA5+DM) complicated by SIH in our single-center cohort, and a comprehensive literature review was performed. Clinical characteristics, treatment, and outcome data of all eligible reported cases were summarized. Potential prognostic effects were identified by comparisons between the deceased and survivors.ResultsAmong cumulatively reported patients with DM patients and SIH, the overall mortality was 60.9% (14/23) (including our cases). Fourteen out of nineteen (73.7%) hemorrhagic events occurred within 6 months of disease onset. Anti-MDA5 antibody predominated in those myositis-specific antibodies available cases (8/10), although patients with positive anti-NXP2 and anti-Mi2 have also been documented. Iliopsoas (52.2%, 12/23) was the most frequently involved bleeding location. Bleeding in deep muscles was identified to be associated with poorer prognosis. The mortality of patients with DM and deep muscular hematoma (non-palpable) (80%, 12/15) was significantly higher than that of patients with only superficial muscular hematoma (palpable) (25%, 2/8) (p =0.023).ConclusionSpontaneous hematoma in non-palpable deep muscles probably leads to excess mortality in dermatomyositis, particularly for those with anti-MDA5 antibody, which often occurs within 6 months of disease onset. Clinicians should be vigilant to this rare but potentially fatal complication and carefully balance the risks and benefits of prophylactic anti-thrombotic treatment.

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

MO209NUOVI PROTOCOLLI TERAPEUTICI NEI PAZIENTI NON IDONEI AL TRAPIANTO CON AMILOIDOSI AL: FOLLOW UP A LUNGO TERMINE

Abstract Background and Aims Immunoglobulin light-chain (AL)amyloidosis is a rare life-threatening disease caused by light chains that are toxic to vital organs such as the kidneys. New therapeutic strategies with bortezomib and lenalidomide have improved the prognosis. The aim of our study was to evaluate the long term efficacy of therapeutic protocol utilizing bortezomib in induction and in conditioning with lenalidomide for PRR (partial renal response) AL renal Amyloidosis transplant-ineligible patients. Method This is a prospective analysis of 16 transplant-ineligible patients with histological diagnosis of renal amyloidosis admitted to our Nephrology Department from 01/2010 to 01/10/2020. All patients have overt nephrotic syndrome at the diagnosis. Two/thirds of them have renal failure. The diagnosis of amyloid is based on the kidney biopsy finding, by light microscopic examination, of amorphous extracellular Congo red positive deposits, which display characteristic dichroism and apple green birefringence under polarised light. Bortezomib-based (BD) regimen is used (Bortezomib 1.3mg/m2 subcutaneously; Cyclophosphamide 200mg/m2 and Dexamethasone 40mg) for 9 cycles. Hematological and organ response were evaluated according to the novel criteria of the International Society of Amyloidosis. The patients with partial renal response (PRR: decreased of 24 hour urine protein and serum creatinine > 50% over baseline) were treated with cycles of Lenalidomide (dose adjustments for renal function, orally on days 1 trough 21 of each 28-days cycle) in combination with dexamethasone and prophylactic anti-thrombotic treatment. Results The mean age was 63±7 years and 7/16 (43.7%) were males. By immunohistochemistry the protein composition of the amyloid deposits was FLC k in 6/16 and FLC lambda in 10/16. Periombelical fat aspirate was positive in 5 patients (31.2%). At onset the mean proteinuria was 13.1 ± 3.6 gr/24h with average MDRD of 37.2 ml/min (III stage CKD), average pro-BNP 420.1 and SIV 12.5 mm. At onset three patients (18.7%) had confirmed multiple myeloma (Clone of plasma cells proliferation > 30% in the bone marrow). 3/16 patients died for cardiac arrhythmia at 3 and 4 months after CyBorD cycles initiation. Therefore CyBorD regimen was completed in 13/16 patients. After 9 CyBorD cycles: 3/13 patients showed a complete renal response (CRR: MDRD > 90 ml/min, proteinuria/24h< 300 mg) and CHR (normal serum FLC ratio); 10/13(76.9%) showed a PRR and PHR (dFLC decrease >50% compared to baseline), one patient died for Sepsis, All patients with CRR or PRR showed a complete cardiological response (normal BNP and SIV). Adverse events during therapy: HZV nevralgy in 3. The 9 patients in PRR were treated with Lenalidomide. After median 6 treatment cycles 7/9 (77.7%) patients showed a CRR and CHR. Haemodialysis was started in 2/9 (22.2%) patients. We decided to discontinue the therapy for adverse events in 3 patients: breast cancer in one, transient troponin I increase and angina in an other patient, pneumonia events in one. The pneumoniae infectious and anginal episodes regressed with drug discontinuation. Median follow-up time from diagnosis of Renal Amyloidosis was 46 months. Median follow-up from the start of Lenalidomide was 36 months. One patients died for breast cancer, but in CRR. All the others patients with CRR (9/13, 69.2%), including the two who suspended Lenalidomide for its toxic effects have been in remission for 30 months on average. Conclusion We conclude the following Lenalidomide therapy is very effective at increasing the number of CRR. In addition, the two treatment regimens (induction therapy with CyBorD and conditioning with Lenalidomide) kept patients in remission for more than 30 months on average. Further studies on larger samples are needed to validate the data.

Acute liver damage in Hyperemesis gravidarum — case report

Hyperemesis gravidarum (HG) involves severe, persistent, intractable nausea and vomiting, which subsequently leads to weight loss>5% of weight until pregnancy, in the absence of other causes, accompanied by dehydration, nutritional deficiency with ketosis, abnormalities electrolyte and/or acid-base balance disorders. in the paper we present the case of a 26-year-old woman, G2N1, in week 10 of gestation, who developed in the context of HG severe abnormalities, namely acute liver damage, with hepatopriv syndrome (Prothrombin after Quick 53%, INR -1, 42, total protein 46.91 /l, cholestatic syndrome (total bilirubin 39 mcmol/l) and cytolytic syndrome (ALT — 140.25 IU / L and AST -125.42 IU / L); alkalemia (arterial pH 7.51) , hyponatremia (serum sodium 132 mmol/l), hypokalemia (serum potassium 2.72 mmol/l). The diagnosis of HG, complicated by acute liver failure, has been confirmed. All laboratory symptoms and abnormalities were resolved by targeted administration of intravenous fluids, antiemetic treatment, and prophylactic antithrombotic treatment.

Venous thromboembolism in COVID-19: A systematic review and meta-analysis.

Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies (n = 6459; 33 in Europe), 17 studies (n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies (n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.

Biologically Active Tissue Factor-Bearing Larger Ectosome-Like Extracellular Vesicles in Malignant Effusions from Ovarian Cancer Patients: Correlation with Incidence of Thrombosis.

The development of malignant effusions such as ascites reflects a massive progression of a malignant disease. In patients with ovarian carcinoma, a high amount of ascites (>500 mL) is an independent negative prognostic marker. The composition and constituents of ascites reflect the inflammatory environment of the underlying tumor. Increased cellular resistance of ascites-derived tumor cells and the development of venous thromboembolic events (VTE) are major risks for these patients, especially in patients with advanced ovarian carcinoma. In this study, we discuss the release of tissue factor-bearing extracellular vesicles (TF+ EVs) from tumor cells into the environment (ascites fluid) and their systemic spreading as a possible causal explanation of the pathologic coagulation status in these patients. We obtained ascites from patients with advanced ovarian carcinoma, collected during surgery or therapeutic paracentesis (n = 20). Larger ectosome-like EVs were isolated using sequential centrifugation, quantified by high-resolution flow cytometry and analyzed using nanoparticle tracking analysis. Furthermore, the pro-coagulant properties (TF activity) of EVs were determined. Compared to published TF activities of EVs from healthy persons, TF activities of EVs derived from ascites of patients with ovarian cancer were very high, with a median of 80 pg/mL. The rate of VTE, as reported in the patient files, was high as well (35%, 7 out of 20). Furthermore, all but one patient with VTE had EV concentrations above the median within their ascetic fluid (p < 0.02). Since VTE continues to be a frequent cause of death in cancer patients, prophylactic antithrombotic treatment might be worth considering in these patients. However, given the risk of bleeding, more clinical data are warranted. Although the study is too small to enable reaching a conclusion on direct clinical implementation, it can well serve as a proof of principle and a rationale to initiate a prospective clinical study with different patient subgroups. We also show ex vivo that these larger ectosome-like EVs induce intracellular ERK phosphorylation and tumor cell migration, which is not directly related to their pro-coagulative potency, but might help to understand why cancer patients with thromboembolic events have a poorer prognosis.

The pulmonary embolism after switching from letrozole to tamoxifen in a patient with breast cancer. A case report and literature review

Women with breast cancer are affected by deep venous thrombosis and/or pulmonary embolism 3 times more often than the group of healthy women in the same age. Thrombosis can be the first manifestation of a malignant disease, but it can also result from hormonal therapy with aromatase inhibitors or tamoxifen which is used in cancer treatment. The necessary clinical problem to solve in this population is the issue of prophylactic antithrombotic treatment. In this paper we present a case of pulmonary embolism in the course of the breast cancer, which was associated with tamoxifen hormone therapy and inadequate thromboprophylaxis.

Venous Thromboembolism During Treatment with Antipsychotics: A Review of Current Evidence.

This article summarises the current evidence on the risk of venous thromboembolism (VTE) with the use of antipsychotics. An increasing number of observational studies indicate an elevated risk of VTE in antipsychotic drug users. Although the use of certain antipsychotics has been associated with VTE, current data can neither conclusively verify differences in occurrence rates of VTE between first- and second-generation antipsychotics or between individual compounds, nor identify which antipsychotic drugs have the lowest risk of VTE. The biological mechanisms involved in the pathogenesis of this adverse drug reaction are still to be clarified but hypotheses such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinaemia and hyperprolactinaemia have been suggested. Risk factors associated with the underlying psychiatric disorder may at least partly explain the increased risk. Physicians should be aware of this potentially serious and even sometimes fatal adverse drug reaction and should consider discontinuing or switching the antipsychotic treatment in patients experiencing a VTE. Even though supporting evidence is limited, prophylactic antithrombotic treatment should be considered in risk situations for VTE.

Management of patients with atrial fibrillation and chronic kidney disease in light of the latest guidelines.

Atrial fibrillation (AF) frequently occurs in patients with chronic kidney disease (CKD), and the rate reaches even 30% in patients with end-stage renal disease (ESRD). Patients with AF and CKD have a significantly higher risk of thrombotic complications, particularly ischemic stroke, and at the same time, a higher bleeding risk (proportionally to the grade of renal failure). In addition, AF and CKD share a number of comorbidities and risk factors, which results in increased mortality rates. Moreover, disturbances in hemostasis are common complications of kidney disease. Their occurrence and severity correlate with worsening renal function, including ESRD. At present, the incidence of bleeding is declining, while thrombotic complications have become the predominant cause of mortality. Prophylactic antithrombotic treatment reduces the rate of stroke and other thrombotic complications. Vitamin K antagonists (VKAs) have long been used in anticoagulant therapy, and more recently, non-vitamin K oral anticoagulants (NOACs) have been introduced, which are direct thrombin inhibitors. NOACs are a valuable anticoagulant option in this group of patients as long as a summary of product characteristics is followed. They are at least as effective as warfarin, while being safer, especially when it comes to intracranial hemorrhage. Renal function should be evaluated before initiation of NOACs and reevaluated when clinically indicated. Importantly, disturbances in hemostasis in patients with CKD and ESRD may lead to unexpected complications, such as extensive bleeding. If anticoagulation is administered to patients on dialysis, effects of an individual dialysis modality as well as interactions with other drugs given (eg, heparin) should be considered.

Embolic signals during routine transcranial Doppler ultrasonography in aneurysmal subarachnoid hemorrhage.

Introduction. Cerebral emboli may occur in subarachnoid hemorrhage (SAH) and intracranial aneurysm surgery. Although embolic signs (ES) have been reported in SAH, their origin remains unclear. The aim of this study was to report the detection of ES during routine TCD monitoring in patients with aneurysmal SAH. Methods. A total of 105 patients with aneurysmal SAH were submitted to TCD evaluation. Patients were monitored almost daily (5 times per week). In each monitoring session, one experienced operator performed TCD to detect or assess vasospasm and ES in arteries of the Willis polygon. Results. Four patients out of a total of 105 patients with aneurysmal SAH were found to present spontaneous cerebral embolization during routine TCD monitoring. The average age of the 4 patients (mean ± standard deviation) was 59.5 ± 8.34 years (range 49–68 ys); female patients predominated representing 75% (3/4) of subjects. Conclusion. Although detection of ES was relatively rare in this study, rates of emboli occurrence may be higher under systematic monitoring. The detection of ES after SAH surgery reinforces the need to study the role of embolus in this condition and may be an indicator for prophylactic antithrombotic treatment.

Cancer-associated venous thromboembolism: risk assessment, prevention, and treatment

The association between cancer and the development of venous thromboembolism is well documented. Cancer-related venous thromboembolism is associated with worsened short-term as well as long-term survival—it also affects the quality of life of the patient and may delay ongoing treatment. Interaction of cancer cells as well as effects of chemotherapy can lead to a systematic activation of coagulation system. Consequently, venous thromboembolism in cancer patients has been associated with several tumor-, treatment- and patient- related risk factors. Several studies focused on possibilities to predict the risk of venous thromboembolism in cancer patients. However, patient selection for prophylactic antithrombotic treatment remains a matter of controversy. In contrast, treatment of cancer-associated venous thromboembolism using low molecular weight heparin is well established. The role of the novel anticoagulants—new oral factor Xa and thrombin inhibitors in the treatment of cancer patients with venous thromboembolism remains to be determined. In this review, recently published studies and guidelines regarding risk assessment, prevention, and treatment of cancer-associated venous thromboembolism are summarized.

GRP-024 Antithrombotic Prophylaxis in Patients with Multiple Myeloma Being Treated with Lenalidomide

BackgroundThe diagnosis of multiple myeloma (MM) has been associated with a greater risk of thromboembolic events. At the same time, the treatment with lenalidomide, an immunomodulator authorised in 2007 by...

Risk of venous thromboembolism due to antipsychotic drug therapy

An increasing number of reports suggest a link between venous thromboembolism (VTE) and the use of antipsychotics. To better understand this association the available body of evidence has been critically scrutinised. Relevant articles were identified in the databases Scopus and PubMed. Several observational studies using different methodologies show an increased risk of VTE in psychiatric patients. This elevated risk seems to be related to the use of antipsychotic medication and in particular to the use of clozapine and low-potency first-generation drugs. Many studies investigating the association have, however, methodological limitations. The biological mechanisms involved in the pathogenesis of this possible adverse reaction are largely unknown but several hypotheses have been suggested such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinemia and hyperprolactinemia. The association may also be related to underlying risk factors present in psychotic patients. Physicians need to be aware of this possible adverse drug reaction. Although supporting evidence has not been published they should consider discontinuing or switching the antipsychotic treatment in patients experiencing VTE. In addition, although data is lacking, the threshold for considering prophylactic antithrombotic treatment should be low when risk situations for VTE arise, such as immobilisation, surgery and so on.

Complicated Henoch-Schönlein Purpura And Antiphospholipid Syndrome: A Rare Association

HenochSchonlein purpura (HSP) is the most common vasculitis in pediatric patients, with a small vessel vasculitis characterized by palpable purpura, arthritis, renal and gastrointestinal involvement. We present the case of a child, showing signs of Henoch– Schonlein purpura, who developed an acute scrotum and some days later an acute abdomen. He presented a prolonged activated partial thromboplastin time (aPTT) and Antiphospholipid antibody tests were positive for lupus anticoagulant antibodies. This suggests that an antiphospholipid syndrome should be considered in cases of Henoch– Schonlein purpura and antiphospholipid antibodies should be measured to determine whether prophylactic antithrombotic treatment is needed to prevent thrombotic manifestations.

Prophylaxis of thromboembolic complications after the Fontan operation (total cavopulmonary anastomosis)

Thrombotic events have been reported as a major cause of morbidity after the Fontan procedure. There is no consensus concerning the postoperative mode and duration of anticoagulation prophylaxis. In a retrospective study, we evaluated the results of a prophylactic regimen on the basis of the surgical technique, potentially predisposing risk factors, and specific sequelae. We evaluated 142 surviving patients after total cavopulmonary anastomosis (mean follow-up was 91.1 +/- 43.9 months). Prophylactic antithrombotic treatment was initiated in 86 patients with partial prosthetic venous pathway with acetylsalicylic acid; 45 patients with complete autologous tissue venous pathway or partial prosthetic venous pathway received no anticoagulation, and 11 patients received warfarin sodium (Coumadin). During long-term follow-up, 22 patients (12 after acetylsalicylic acid medication) crossed over to warfarin. Thrombotic events occurred in 10 patients (7%), with systemic venous thrombus formation in 8 (5.6%), stroke in 2 (1.4%), and a peak incidence during the first postoperative year. Eight of 10 patients were receiving heparin therapy mainly for prolonged postoperative immobilization. During follow-up, none of the 74 patients receiving acetylsalicylic acid and 1 of 40 patients without medication presented with thrombus formation. Under warfarin medication, 1 of 28 patients had an asymptomatic thrombus. Expected freedom from a thromboembolic event was 92% at 5 years and 79% at 10 years. There was no association with coagulation factor abnormalities. Protein-losing enteropathy was present in 4 of 10 patients. A prophylactic anticoagulation strategy that considers the surgical technique and potential predisposing circumstances proved effective in the prevention of late thrombotic complications after total cavopulmonary anastomosis. There is no need for routine anticoagulation during long-term follow-up after Fontan-type surgery in pediatric patients.

Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports

The use of subcutaneous infusion ports has become standard practice to provide a long-term venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our population and to identify predisposing factors. We reviewed the medical records of 437 patients who were followed at the Oncology/Haematology Department of our hospital. Of these patients, there were 370 (84.4%) with solid tumours and 58 (13.2%) with haematological disease. The position of the catheter tip was evaluated by reviewing the available chest radiographs or phlebographies. Analysis of the records showed that 346 patients (79.17%) had no complications. The most common complications after implantation were thrombosis (8.46%), catheter dysfunction (4.8%) and infections (4.4%). Univariate and multivariate analysis showed that catheter tip positioning was the most important predisposing risk factor for thrombosis. Catheter tips positioned in the brachiocephalic vein or in the cranial part of the superior vena cava were associated with a high risk of thrombosis. Other significant risk factors were gender and initial diagnosis. Female patients and patients with lung cancer also had an elevated risk of developing a thrombosis. Compared to other reports, we noted a higher rate of thrombosis and port dysfunction. Since catheter tip position was a predisposing factor for developing a thrombosis, correct catheter position has to be ensured during placement. Prophylactic antithrombotic treatment might be beneficial in the event of failure to position the catheter correctly.

High frequency of congenital thrombophilia in women with pathological pregnancies?

The obstetrical complications preeclampsia, intrauterine growth restriction (IUGR), placental abruption and fetal loss are major causes of maternal and fetal morbidity and mortality. Much recent research has focused on to what extent congenital thrombophilia contributes to these obstetrical complications. Combined with the hypercoagulable state of pregnancy, thrombophilia has the potential to induce placental thrombosis and cause placental insufficiency with subsequent obstetrical complications. This article aims to review and discuss published clinical studies of the relationship between congenital thrombophilia and preeclampsia, IUGR, placental abruption and fetal loss. In addition, the few published clinical trials of prophylactic antithrombotic treatment to prevent severe obstetrical complications in thrombophilic women are discussed. The studies have shown variable results evaluated mainly as a result of the limited number of case reports published. However, the strongest association was found to be between congenital thrombophilia and preeclampsia and late fetal loss. Early fetal loss was not found to be associated with congenital thrombophilia. At present, the question remains open as to whether IUGR and placental abruption is directly associated with thrombophilia or mediated through preeclampsia. In conclusion, the associations between congenital thrombophilia and preeclampsia, IUGR, placental abruption and fetal loss only reaches evidence grade 4. Present recommendations and clinical guidelines are thus based on weak scientific proof.

High frequency of congenital thrombophilia in women with pathological pregnancies?

The obstetrical complications preeclampsia, intrauterine growth restriction (IUGR), placental abruption and fetal loss are major causes of maternal and fetal morbidity and mortality. Much recent research has focused on to what extent congenital thrombophilia contributes to these obstetrical complications. Combined with the hypercoagulable state of pregnancy, thrombophilia has the potential to induce placental thrombosis and cause placental insufficiency with subsequent obstetrical complications. This article aims to review and discuss published clinical studies of the relationship between congenital thrombophilia and preeclampsia, IUGR, placental abruption and fetal loss. In addition, the few published clinical trials of prophylactic antithrombotic treatment to prevent severe obstetrical complications in thrombophilic women are discussed. The studies have shown variable results evaluated mainly as a result of the limited number of case reports published. However, the strongest association was found to be between congenital thrombophilia and preeclampsia and late fetal loss. Early fetal loss was not found to be associated with congenital thrombophilia. At present, the question remains open as to whether IUGR and placental abruption is directly associated with thrombophilia or mediated through preeclampsia. In conclusion, the associations between congenital thrombophilia and preeclampsia, IUGR, placental abruption and fetal loss only reaches evidence grade 4. Present recommendations and clinical guidelines are thus based on weak scientific proof.

Tiefe Beinvenenthrombose nach alloarthroplastischem Hüftgelenkersatz

Deep vein thrombosis requires intensive therapy--either the patients require hospitalisation or their rehabilitation scheme must be adjusted and medical treatment applied. The total number of patients with deep vein thrombosis undetected before admission to rehabilitation facilities is unknown. Study parameters: 1. The occurrence of undetected deep vein thrombosis upon admittance to a rehabilitation facility. 2. The value of sonography in diagnosing, localising and determining the extent of deep vein thrombosis and 3. the influence of prophylactic antithrombotic treatment applied in the surgical hospital, as well as during the intermittent outpatient phase before admittance to the rehabilitation centre, on the occurrence of deep vein thrombosis. 305 patients were examined between Nov. 95 and Dec. 96. The first check was carried out on the day of admission (on the 26th postoperative day, on average). The second check was done on the day of discharge from the rehabilitation centre. Deep vein thrombosis was found in 30 patients (10%). In 27 cases the thrombosis was located in the thigh, in one case it was found in the contralateral leg. 18 of these patients had been discharged from the surgical hospital on the 22nd postoperative day, for an average time of 7 days of outpatient care, before being admitted to the rehabilitation centre. 11 of these patients had not received any prophylactic antithrombotic treatment. One patient developed deep vein thrombosis of the thigh during the rehabilitation phase despite of prophylactic treatment. Postoperative sonographic screening of all patients undergoing hip surgery is a useful method to detect deep vein thrombosis. Prophylactic postoperative antithrombotic treatment in the rehabilitation phase is mandatory.